Heart Attack Deaths Higher Among Blacks

NEW YORK (Reuters Health) - The death rate following a heart attack is significantly increased at hospitals that disproportionately serve black patients, according to a new report. Previous reports have shown that blacks are more likely than whites to be treated by physicians with less training or at hospitals where it takes longer for treatment for a heart attack to be started. However, the impact of these differences on outcomes was unclear.

To investigate, Dr. Jonathan Skinner, from Dartmouth Medical School in Hanover, New Hampshire, and co-investigators analyzed data on more than 1 million Medicare patients who were hospitalized for a heart attack between 1997 and 2001. The study included 4289 hospitals that were rated from 1 to 10 based on the extent to which they treated to black patients, the team explains in the American Heart Association's journal Circulation. Category 1 hospitals treated no black heart-attack patients during the study period, whereas at category 10 hospitals about one third of all heart-attack patients were black.

The percentage of patients who died within 90 days after suffering a heart attack was significantly higher in category 10 hospitals compared with category 1 hospitals: 23.7 percent vs. 20.1 percent. The researchers found that the difference in mortality between category 1 and category 10 hospitals could not be explained by income, hospital ownership status, the volume of heart attacks treated at the hospital, census region, or urban status. In a related editorial, Dr. Nancy R. Kressin, from Boston University School of Public Health comments, "The evidence to date suggests a discouraging picture of racial disparities in cardiovascular care, and Skinner and coworkers' study documents disparate outcomes associated with segregated care. It is still not clear what proportion of the life expectancy gap in cardiovascular disease is explained by disparate care."
SOURCE: Circulation, online October 25, 2005.
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